Surgical apparatus



v v 7 1,627,714 M y 0, 1927. I sQRESl SURGICAL APPARATUS Fi led Nov. 30. 1925 Z'SheetS-Sheet 1 lllll 6.

29 2 I r I '32 1 U INVENTOR [Inge/0i. Jararz' 15,, ATTORNEY 1,627,714 May 10,1927. A'LSORESL v SURGICAL APPARflTUS Filed Nov. 1925 2 Sheets-Sheet 2 I 4 a/ :34 Q

m ATTORNEY Patented May 10, 1927.

v 1,627,714 OFFICE.

ANGELQ L. sonasi, orjunwvoax, n. Y.

SURGICAL AerARArns.

' Application filed November This invention relates to surgical appa ratus, and has for its primary obgect to provide certain important improvement'sv in an.

apparatus of the character disclosed in my prior application for patent Serial No. 713,-

8787, filed May 17, 1924:, whereby the effi cient operation of the apparatus. and its. general utility in the performance of various surgical operations will be increased.

htlore particularly, by means of my present improvements I propose to. provide an apparatus which maybe easily operated for the practically uninterrupted or continuous transfusion of blood and whereby the pos chemical modification or change whatever in the blood duringtranstusion will be preclude-d. In accon'iplishing this result, as in my prior applicatioml employ a flow controller having freely movable gravity seated ingress and'egress ball valves. In my present imp-roven'ients, as will be hereinafter described in detaihl provide an im proved form of seat for these gravity mov able valves whereby the contact of the metal valve ball with the metallic stop member is substantially confined or limited to a single point or line upon the spherical surface of the ball. I have found that this construction, while providing a fluid-tight closure when the valve is seated, practioally'renders impossible any clogging or coagulation of the blood or the accumulation of fibrin up on the surface of the valve ball.

Another important object of my present invention is to provide an'improved means for mounting and supporting the flow controller so that it is impossible to arrange said controller in other than the correct position.

An additional feature of my improvei'uents residesin simple and novel means for.

removably mounting or supporting a syringe and opcratively connecting the same with the flow controller.

lVith the above and other objects in view, the invention consists in the improved surgical apparatus, and in the form, construction and relative arrangement of its several parts as will be hereinafter more fully described, illustrated in the accompanying drawings, and subsequently incorporated in the subjoined claims. i I

In the drawings, wherein I have illustrated one simple and satisfactory embodiment of my present improvements and in sibilit V of clottim or coa ulation or an 30, 1325. Serial No, 12,366,

which similar reference characters designate corresponding parts throughout the several views,- u v Figure 1 is a side elevation of the device;- Fig. 2 is a sectional plan view taken on the line 2+2 of Fig. 1;

Fig. 3 is a vertical sectional view; Fig. 4 is. a section taken on the, line 44l otf Fig. 3; i

Fig-f5. is a detail enlargedisectionalview" 01 the egress nipple and ball valve of the flow controller, and

F 6: is a similar vlew of the egress valve showing the valve ball at the; limit of its.-

opening movement.

As herein shown, the several essential par-ts of the apparatus are removably mounted and arranged upon a suitable support, said support preferably embodying-a elongated metal base 5. provided with integrally formed arm Gand 7 respectively,

the rear arm 7 being vertically disposed and provided on its upper end w1th a hori-.v

zontal tubular e'i'etension 8 internally threaded as at 9 for a purpose which will be presently explained. r

The other arm 6 has a forwardly extending horizontal portion 10, the end of which is upwardly extended and inwardly curved asat 11 and terminates in a concave seat 12. The horizontal part 10 of the arm 6 has a vertical opening 13 formed therethrough and at the upper end of said opening is formed with a'shghtly raised seat 14/ The base 5 at the rear end of the vertical arm 7 has a transversely extending groove or channel 15 formed in its upper surface. While, owing to the construction of this support may be conveniently grasped and held in one hand while the apparatus is operated by the other hand, 1 have indicated in the accompanying drawings several ways in which the support may be d-etachably clamped and rigidly held upon a suitable table or board arranged between two beds. Thus, the under side of the base 5 intermediate of its ends may be provided with a threaded socket 16 to receive the upper end of a screw 17 disposed through an opening 19 in the base board 18. A suitable clamping nutQO is threaded upon .saidscrew for en gagement against the under side of the board 18. As an alternative clamping means the yoke shown at 21 may be employed, one arm of said yoke extending beneath the board support for the parts of the apparatus, said l r 18 and carrying the clamping screw 22 while the other arm of the yoke is positioned above the board and terminates in a curved part 23, the extremity of which is adapted for engagement in the groove 15 of the supporting base 5, when said base is disposed at right angles to the length of the board. On the other hand, when the support is arranged longitudinally of the board 18 adjacent one of its side edges, the curved part 23 of the yoke arm may then be engaged upon a rounded surface of the base 5 between the spaced arms 6 and 7 thereof, as illustrated in Fig. 4 of the drawings.

The essential parts of the apparatus include a flow controller. As herein shown, this flow controller consists of a body 24 preferably of cylindrical form. This body 24 is provided with a central longitudinally extending bore or passage 25 having an enlarged and preferably "flared or conically formed ingress end 26. At the juncture of the intermediate portion of said passage with said flaring ingress end thereof grooves or channels 27 in the opposite sides of the bod connect said ingress end 26 to the interinetiate part of the channel 25 on opposite sides of the juncture point indicated .at 28, said juncture point formed by the meeting surfaces of the central part of the channel 25 and its enlarged end 26 constituting a valve sto The opposite or egressend of the channel 25 is counterbored or enlarged as at 29 to provide a valve seat 30, and beyond said counterbore 29, the passage opening upon the end of the body 24 is flared or conically formed as at 31.

' Each end of the controller body 24 is exteriorly threaded to receive an interiorly threaded cap 32, each of said caps being formed with a flange to detachably retain a nipple 33 and 34 respectively in connection with the opposite ends of the controller body. Each of these nipples has a frustro conical head 35 and 36 and the tapered peripheral surfaces of these heads have snug fitting contact within the flaring ends 26 and 31 respectively, of the liquid passage through the controller body and are held in fluid and air tight engagement therewith by the threaded caps 32. The other ends of the nipples are suitably formed for the attachment of lengths of tubing 37 thereto, each length of tubing being adapted for connection at its other end with a suitable needle, one of which I have indicated at 38.

The end of the nipple 33.0pposed to the ingress end 26 of the passage 25 is counterbored as at 39 to provide the valve seat 40. The end of the bore of the other nipple 34 connected with the egress end of the passage 25 is enlarged or flared as at 41, the juncture of said enlarged end with the bore through the nipple providing the valve stop eanna 42. The nipple head is alsoprovided'with grooves or channels 43 connecting the flaring end 41 of the bore to the main portion thereof at opposite sides of the stop 42.

The gravity movable valve balls 44 and 45 operate in conjunction with the stops and seats 28 and 40 and 42 and 30 respectively, in a manner which will be presently more fully referred. to. valves are seated by gravity upon the lower seats 40 and 30 respectively as shown in Fig. 3 of the drawings.

The nipple 34 is formed with an annular flange indicated at 46 which is of greater diameter than the opening 13 in the supporting arm 10 while the nipple 33 is not provided with such a flange. Thus, only the latter nipple can be positioned through the opening 13, which insures the correct arrangement or mounting of the flow controller with the gravity ball valves properly cooperating with their respective seats to control the ingress and egress of the liquid.

For the purpose of producing a substantially continuous and uninterrupted flow of the liquid through the controller from the lower tube 37 to the upper tube 37, I provide a syringe of suitable construction. As herein shown, this syringe consists of a cylindrical metal barrel 47 having a tapering longitudinal extension 48 on one end through which the, small diameter outlet duct 49 is formed. The other end of the syringe bar rel has a convex bead or flange 50 formed thereon adapted for seating engagement against the tapered or conical internal surface 52 formed in one end of a bearing member 51, the other end of which is of reduced diameter and is loosely interlocked as at 53 with one end of a hollow cylindrical nut 54. This nut is externally threaded at 55 for engagement with the threads 9 in the upper end of the extension 8 on the supporting arm 7.

A plunger 56 of suitable construction is contained in the syringe barrel 47 and has a rod 57 connected thereto and extending through an opening in the outer end of the nut 54, said rod being provided with a suitable operating handle 58. A coil spring 59 surrounding said rod bears at one of its ends against the plunger 56 and at its other end against the end wall of nut 54. The body 24 of the flow controller is provided with a radially extending tapered opening 6 therein communicating at its inner end w th the channel or passage 25 substantially and way of its length. 7

In mounting the flow'controller and the syringe upon the support, the flow controller is perpendicularly positioned and the nipple 33 inserted downwardly through opening 13 in the arm 6 until thecap 32 is engaged upon the seat 14. The cylindrical body 24 of the flow controller will thus be Normally, these positioned against the concave seat 12 on the end 11 of the supporting arm. The syringe barrel 2'? is now inserted through the opening of the arm extension 8 and the reduced tapering extension 48 on the end of said barrel is engaged in the tapered radial opening 60 ofthe controller body. The cylindrical nut 54 is then threaded into the extension 8 and the bearing member 51 is caused to exert a longitudinal pressure against the barrel 47, thus forcing the surface of the tapered outlet extension 48 of said barrel into tight frictional contact against the wall of the opening 60 and securing an air and fluid tight seal between the outlet of the syringe barrel and the body of the flow controller 24. The apparatus may now be detachably secured in a convenient position upon a supporting board or other base by any one of the several clamping means shown in the drawings.

In the use of the apparatus for the transfusion of blood each of the tubes 37 is provided at its free end with suitable needles for insertion in the veins of the donor and recipient, respectively. The donors tube 37 is connected with the lower or inlet nipple 33 of the apparatus while the recipients tube is connected with the upper or outlet nipple 34'. It will now be apparent that when the operator or surgeon draws the piston 56 outwardly from the barrel 47 against the action of spring 59, a suction effect is created in thechannel or'passage of the flow controller, such suction acts'to hold the upper gravity seated ball valve 45 in close contact upon its seat to prevent any pos sibility of the creation of a vacuum in the recipienfis tube 37 which would withdraw blood from the vein of the recipient. Such suction effect at the same time lifts the lower gravity seated ball valve 44 and does create a vacuum within the donors tube 37 so that blood is drawn from the vein of the donor through the needle and into said tube and hence through thenipple 33 and into channel 25, the blood flowing from said channel through duct 34 into the syringe barrel 47. Preferably, this syringe barrel has a liquid receiving capacity of approximately 2 cc. It will be noted that the raisingor lifting of the lower valve ball is limited by the upper stop 28. However, the holding of the valve in this raised position does not appreciably impede the flow of the blood which may pass freely around the valve ball and through the grooves or channels 27' at opposite sides of the stop 28 into passage 25.

Upon the release of the syringe plunger it is projected to its normal position in the barrel 47 by the s ring 59 and thereupon the lower valve bill 44. instantly drops by gravity to the seat 40 and closesthe ingress nippic 33 while the pressure of the blood ex pelled bythe syringe piston 57 lifts the upper valve ball against the action of grai ity until it contacts with stop 42.v The blood is thus forced under pressure through passage 25 around the valve ball 45 through the grooves or channels 43 into the recipients tube 37, from which it is finally expelled under pressure through the bore of the needle 38 into the vein of the recipient. It will be noted that in the construction of the several parts of this apparatus and particularly of the'passages, chambers or cavities through which the blood flows, sharp corners forming pockets in which the blood might collect and stagnate are eliminated. Since all parts of the apparatus are perfectly air-tight, it is also apparent that no air can be drawn into the passages or channels thereof in the operation of the syringe so that absolutely whole unmodified blood is transferred from the vein of the donor to the vein of the recipient. Since these passages through which the blood flows are very accurately formed in accordance with the vacuum producing action of the syringe, no voids or dead air spaces'will be produced. The possibility of ebullition or churning of the blood in its flow which might, to some extent, modiiy its chemical analysis is elimi nated. Owing to the instantaneous action of the gravity seated ball valves, such apparatus insures a practically continuous and uninterrupted flow of the blood from the donor to the recipient during the operation of the syringe. Further, it will be observed that dueto the construction of the ball valve stops and the exceedingly limited area of contact between the stops and the peripheral surfaces of the respective valve balls, pos sible coagulation of the blood or the collection of fibrin upon such surfaces is obviated. Thus, there is no opportunity for a static condition to exist in'any part of the appara tus and practically the only change which occurs from that naturally existing in the vein of the donor is that a pressure some what in excess of the natural pressure existing in thehuman body is impressed upon the flowing stream of blood as it enters the recipients tube 37. This is necessary in order to overcome the natural pressure of the blood stream in the vein of the recipient and preclude any back pressure tending to impede the flow of blood from the recipients needle- It is equally important of course, that there shall be no back pressure of the blood through the donors needle connected with the lower tube 37, and this is insured by the instantaneous closing of the lower ball valve by the action of gravity upon the release of the syringe plunger. It will be understood that the tubes 37 are as short as possible so that the time elapsing between the withdrawal of blood from the vein of the donor and its admission into the vein of the recipient is reduced to a minimum, thus avoiding any possible chemical modification of the blood which might result from an appreciable decrease in its temperature.

i fter the desired quantity of blood has been transfused from the donors to the recipients vein, the needles 38 are withdrawn and the syringe and the flow controller then removed from the supporting structure and their several parts disassembled and thoroughly sterilized. It will be appreciated that owing to the construction of the several parts, such thorough sterilization thereof may be easily and quickly effected.

In addition to the use of such an apparatus for the purpose of blood transfusion, it may obviously also, be utilized for the more effective performance of numerous other allied surgical operations. Thus, I have used my new apparatus with marked success in the operations of auto-transfusion of blood, local infiltration, regional anaesthesia, hypodermoclysis, paracentesis, and thoracentesis, intravenous injection and blood perfusion. In certain of these operations, a plurality of injection needles are connected with the tubing from the egress end of the flow controller, while in others, only the injection needle is used, the tubing connected with the ingress nipple of the controller having its free end immersed in the liquid to be injected. I

From the foregoing, the construction and manner of operation of the apparatus will be clearly understood. It will be readily seen that such an apparatus in cases of emergency can be quickly applied to use and operated by the surgeon without assistance. I have above referred to the barrel of the syringe as consisting of a metal cylinder, but it will be understood that if desired, a cylinder of glass or other transparent material may be used having metal heads applied at the ends thereof so that the liquid drawn into said cylinder may be visible. Also, while I have herein referred to a preferred construction of the several parts of the apparatus, it will nevertheless, be understood that the essential features thereof might also be embodied in various other alternative structures, and I accordingly, reserve the privilege of adopting all such legitimate changes as may be fairly embodied within the spirit and scope of the invention as claimed.

1 claim:

1. In surgical apparatus, a fluid flow controller including a body member having a longitudinal bore therethrough and" longitudinally spaced valve seats and stops at the opposite ends of said bore, ball Valves arranged between said spaced valve seats and stops and normally seating by gravity on the seats and adapted to be moved under pressure from such normal positions into engagenient with the stops and said stops having fluid passages at the opposite sides thereof whereby the fluid may have ingress to and egress from said bore around the valve balls, each of said stops presenting a single posite sides of said valve stop for they m gress of fluid to said bore when the valve is engaged on said stop, ingress and egress nipples each having an end formed for engagement in one of the flared ends of said bore and said end of the ingress nipple having a valve seat and the egress nipple having a valve stop, and provided with fluid escape I passages at opposite sides of the valve stop, and ball valves arranged between the seats and stops at the opposite'endsof said bore and norixally seated by gravity respectively upon the seat of the ingress nipple and the seat at the egress end of said bore and movable under pressure into engagement with the valve stops, each of said valve stops presenting a single annular'line of contact with the surface of the valve ball, said body member having a transverse openmg communicating with said bore between the valve seats thereof, and a syringe adapted for connection with said transverse opening.

3. In surgical apparatus, a. fluid flow controller including a body member having a longitudinal bore therethrough, ingress and egress nipples connected with opposite ends of the body member, said nipples and the bore of the body member having spaced valve stops, valve balls movable between said stops, a supportfor the flow controller adapted to receive the ingress nipple, the egress nipple being provided with means to prevent the mounting of the latter nipple in the support, and a syringe adapted to be connected with the bore through said body member intermediate of said valve balls.

4. In surgical apparatus, a. fluid flow controller including an elongated body member having a fluid passage therethrough, automatic gravity operating valves at opposite ends of saidpassa'ge responsive to pressure impressed upon the fluid in said passage and permitting of the flow of the fluid through said passage in only one direction, a support upon which said body member is adapted to be mounted in a substantially perpendicular position, and said body member be ing provided with means at one of its ends whereby in the mounting of'said flow controller on the support at opposite ends thereof may be distinguished from each other so that said'controller may not be arranged in an inverted position and the valves thereby rendered inoperative.

5. In surgical apparatus, a fluid flow controller including an elongated body member having a fluid passage therethrough and automatically acting ingress and egress valves at the opposite ends of said passage, said body member also being provided with a transverse opening communicating with said passage, a support 'upon which said member is adapted to be mounted in a perpendicular position, a syringe having a barrel provided with an outlet extension on one end for insertion into said opening, and means for adjustably securing the syringe barrel in position relative to the support and operating to force the outlet extension thereof into fluid-tight engagement with the wall of said opening and simultaneously fix the fluid controller in position on the support. I

6. In surgical apparatus, a fluid flow controller including a body member having a fluid passage therethrough and automatically acting ingress and egress valves at opposite ends of said passage, a support upon which said body member is adapted to be mounted in a perpendicular position and said support having a bearing opposed to one side of said member, said body member also having a transverse opening communicating with said passage, a syringe consisting of a barrel having an outlet extension at one end for engagement in said opening and a spring pressed plunger operating'in said barrel, and adjustable means on the support in which the other end of said syringe barrel is mounted and whereby said barrel may be longitudinally moved to eiiect a fluid-tight connection between the outlet extension thereof and the wall of said opening and simultaneously clamp the body member of the controller against said bearing on the support whereby the syringe and the flow controller are fixed in operative relation with each other on the support. v

7 In surgical apparatus,a support having. a base provided with spaced upstanding arms, a! fluid flow controller adapted to be perpendicularly positioned upon one of said arms and including a body member having a fluid passage therethrough and automatic gravity acting ingress and egress valves at opposite ends of said passage, said arm also having a bearing against which one side of the body member is adapted to be engaged and said body member being provided with a transverse opening communicating with said passage, a syringe removably mounted on the other supporting arm and having a barrel provided with an outlet extension at one end and means for'adjusting said syringe rela tive to the latter supporting armto force said outlet extension into fluid tight engagement with the wall of said transverse opening and simultaneously clamp the controller body against the bearing of said first named .supporting arm whereby the flow controller and the syringe are fixed in their relative operating positions with respect to the support.

In testimony that I claim the foregoing as my invention, I have signed my name hereto.

ANGELO L. SORESI. 

